Complicated EBV infection in a healthy child

Abstract

The Epstein-Barr virus (EBV) is highly prevalent throughout the population. Although in most cases, the infection has a good prognosis, it can cause severe complications. We report a case of a healthy child with a primary EBV infection that evolved with two rare complications. She first presented in the emergency room with fever and sore throat, and was diagnosed with tonsillitis and medicated with antibiotic. She returned 7 days later for fatigue, vomiting and abdominal pain. The examination revealed tonsillitis, swollen cervical lymph nodes and pain in the right hypochondrium. An abdominal ultrasound was performed, compatible with acute acalculous cholecystitis. She was admitted in the paediatric nursery and medicated with intravenous antibiotics. The EBV serology revealed primary infection. Two days later, she developed cardiogenic shock and had to be transferred to an intensive care unit under mechanical ventilation and inotropics. She was discharged 12 days later, keeping a moderate left ventricular dysfunction.

Acalculous Cholecystitis in a Seven-Year-Old Girl With Epstein-Barr Virus Infection

“…Clinical evidence of AAC, however, is not common. There have been eighteen reported cases of pediatric patients with symptomatic EBV-associated AAC [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] although radiographic stigmata may be found in up to 25% of cases of pediatric acute EBV [18]. Surgical and antibacterial therapy have been proposed [6] but no reports of adverse outcome have been associated with expectant management alone.…”

“…It can have a wide range of manifestations, from asymptomatic to systemic, severe disease. Since first being reported in 2007 [ 1 ], there have been reports of 17 additional pediatric patients with acute acalculous cholecystitis (AAC) as a result of EBV infection [ 2 - 16 ]. We present an additional case in which AAC was the clinically dominant manifestation of acute EBV mononucleosis.…”

Is conservative management a safe approach for patients with acute acalculous cholecystitis presenting with an acute abdomen?

“…After identifying 671 articles, 153 articles involving 171 cases were eligible: 104 viral infection and 67 rheumatic disease AAC patients. [8,11–162] Viral infection types included: Epstein Barr virus, hepatitis virus, dengue virus, SARS-CoV-2 (COVID-19), human immunodeficiency virus, and cytomegalovirus. Rheumatic diseases included: systemic lupus erythematosus, adult-onset Still disease, Henoch-Schönlein purpura, polyarteritis nodosa, Churg-Strauss syndrome (eosinophilic granulomatosis with polyangiitis), microscopic polyangiitis, temporal arteritis, Wegener granulomatosis (granulomatosis with polyangiitis), Kawasaki syndrome, systemic juvenile idiopathic arthritis, and juvenile dermatomyositis (Table 1).…”

A case report of multisystemic sarcoidosis with extracardiac shunt

“…Sarcoidosis is an inflammatory disease characterised by the presence of non-caseating granulomas. 1 The disease is often multisystemic and requires the presence of involvement in two or more organs for a specific diagnosis. 1 Despite multiple investigations, the cause of sarcoidosis remains unknown.…”

“…1 The disease is often multisystemic and requires the presence of involvement in two or more organs for a specific diagnosis. 1 Despite multiple investigations, the cause of sarcoidosis remains unknown. The granuloma is the pathologic hallmark of sarcoidosis.…”